This is an example of a transseptal puncture under transesophageal echo (TEE) during a MitraClip procedure at the University of Colorado Hospital. You can see the surgical electro cutter catheter pushing against the septal wall creating a sharp point called “tenting” where the catheter will cut through. The fusion imaging helps guide exactly where the puncture will be made, as the location determines where the MitraClip device will be positioned to make its final approach to the mitral valve lea